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Exploring the psychological aspects of sport injury
Exploring the psychological aspects of sport injury

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3 How can stress increase the risk of injury?

You have seen that stress can be a significant predictor of sport injury, but how exactly can stress lead to a sport injury?

In this section you will explore some of the mechanisms proposed to explain this relationship. The core of the Stress and Injury model (Figure 3) that you explored in the previous section indicates that physiological/attentional responses are responsible. More specifically, three key mechanisms were proposed by Andersen and Williams (1988) in the original version of the model:

  • distraction
  • attention narrowing, and
  • muscle tension.

These are explained in the table below.

Table 1 Mechanisms of how stress can increase the risk of injury
DistractionAttention narrowingMuscle tension
‘I was so preoccupied by the argument I’d had with my husband before I went to the gym that I just wasn’t concentrating on lifting properly.’ (Travis)‘I was so stressed that I wasn’t focusing on what was going on around me and I just didn’t see the tackle coming.’ (Nala, rugby player)‘I was so stressed that I had a lot of tightness and tension around my shoulders when I walked into the gym that day.’ (Travis)
This mechanism suggests that when people are stressed they fail to pay attention to vital cues (e.g. the position of other players) in the sport or fitness environment around them. This can lead to injury when a missed cue leads to an event such as a mis-step (Brewer and Redmond, 2017).Stress can lead to narrowing of the peripheral field of vision. This means that individuals may miss vital cues in their periphery which can increase the risk of injury (e.g. an incoming tackle) (Andersen and Williams, 1988).It is suggested that stress can lead to the somatic (i.e. physiological) response of muscle tension which interferes with flexibility, co-ordination and fluidity of movement thus increasing the risk of injury (Brewer and Redmond, 2017). This inefficient movement may also lead to greater perceptions of fatigue which could also increase the risk of injury.

The next activity explores these mechanisms and the links between stress and injury.

Activity 2 Stress and injury: a sports therapist’s story

Timing: Allow about 30 minutes

Watch Video 3 below in which Dale Forsdyke discusses his experiences of working with injured sport and exercise participants as a sports therapist. Dale has worked as a sports therapist for over 10 years, predominantly working in football. He currently works Head of Science and Medicine at York City Tier 1 Regional Talent Club. In addition to his role as a sports therapist Dale also works as a university lecturer.

As you watch the video, answer the following questions.

  1. Dale discusses how stress can be a risk factor for developing a sport injury. What are some of the sources of stress experienced by the players he works with?
  2. How can the stress experienced by athletes lead to an injury?
  3. What strategies does Dale put in place to try and reduce the risk of injury in the players he works with?
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  1. Dale mentions that the cause of injury is often multifactorial, which means that they can be caused by a multitude of factors, and psychological factors such as having a lot of stress is one of those factors. Stress can come from inside or outside of sport. As the players he works with are quite young exam stress is one of the main sources of stress experienced outside of sport. Examples of sources of stress within sport that Dale mentions include concerns around selection and exiting the programme (transition into the next phase of their football career).
  2. Dale discusses seeing examples of all three mechanisms you looked at in Table 1 – distraction, attention narrowing and muscle tension. He also mentions other mechanism such as sleep disturbance which you will look at in the next section.
  3. Dale discusses three strategies that they put in place to minimise the risk of injury at his club:
    • Routine monitoring of players – they monitor the players’ stress levels at the beginning and end of each session to help identify when a player is under stress and more susceptible to injury.
    • Psychological skills training – the players are taught psychological skills to help them cope with stress. Dale refers to the Football Association’s (FAs) 5 Cs framework which highlights 5 important skills players need to develop – confidence, control, commitment, concentration and communication. You can find out more about this model here [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] . You will look at psychological skills training in more detail in Sessions 4, 7 and 8.
    • Preparing athletes for return to sport – the staff work to ensure that players are mentally ready to return to sport (e.g. confident, low anxiety level) as this can reduce the risk of re-injury.

In Video 3 Dale suggested that there are other mechanisms beyond distraction, attention narrowing and muscle tension that may explain how stress can lead to injury. Some of these are explored next.